Impact of preoperative nutritional support and rehabilitation therapy in patients undergoing pancreaticoduodenectomy

• DOI: 10.1007/s10147-021-01958-0
• Publication Date: 2021-06-04T17:02:47Z
• Authors: Mariko Tsukagoshi; Norifumi Harimoto; Kenichiro Araki; Norio Kubo; Akira Watanabe; Takamichi Igarashi; Norihiro Ishii; Takahiro Yamanaka; Kei Hagiwara; Kouki Hoshino; Ryo Muranushi; Toshiki Yajima; Naoki Wada; Ken Shirabe
• Keywords: Prehabilitation; Surgical oncology; Pancreatic fistula; Preoperative care

Sarcopenia is closely associated with morbidity after pancreatic surgery. We investigated the impact of preoperative nutritional support and rehabilitation on patients undergoing pancreaticoduodenectomy.This was a retrospective analysis of 101 patients who underwent pancreaticoduodenectomy. Skeletal muscle (SM) loss was defined using the SM index (cutoff level: 42 cm2/m2 in men and 38 cm2/m2 in women). A total of 33 and 30 patients received preoperative nutrition and prehabilitation, respectively. The neutrophil-to-lymphocyte ratio (NLR), Prognostic Nutritional Index (PNI), and modified Glasgow Prognostic Score (mGPS) values were calculated during the first visit and immediately before surgery.SM loss was present in 65 of 101 patients and was significantly correlated with female sex, older age, lower body mass index, and low PNI. Preoperative nutritional support and prehabilitation prevented the decrease in PNI values in patients with SM loss. The NLR significantly improved in patients with SM loss who received nutritional support and prehabilitation. In patients with SM loss, the lack of preoperative nutrition and prehabilitation was an independent risk factor for postoperative pancreatic fistula.Preoperative nutritional support and prehabilitation may reduce the incidence of pancreatic fistula in patients with SM loss and improve the surgical outcomes of patients undergoing pancreaticoduodenectomy.